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ekg test Flashcards

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1
Q

Where is the heart located?

A

In the mediastinum, above the diaphragm, behind the sternum, and in front of the spine.

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2
Q

What is the base of the heart?

A

The top of the heart.

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3
Q

What is the apex of the heart?

A

The bottom of the heart.

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4
Q

Approximate size and weight of the adult heart?

A

About 5 inches long, 3.5 inches wide, 2.5 inches thick, and 11 ounces. Roughly the size of the owner’s clenched fist.

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5
Q

What is the function of arteries?

A

Carry oxygenated and nutrient-rich blood away from the heart. Exception: Pulmonary artery carries deoxygenated blood from RV to lungs.

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6
Q

What is the function of veins?

A

Carry deoxygenated blood from the body to the heart. Exception: Pulmonary vein carries oxygenated blood from lungs to LA.

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7
Q

Function of capillaries?

A

Deliver oxygen and nutrients at the cellular level and carry deoxygenated blood back to veins.

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8
Q

What is the endocardium?

A

Inner layer of the heart; made of epithelial and connective tissue; lines cavities, covers valves, continuous with vessels; contains Purkinje fibers.

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9
Q

What is the myocardium?

A

Middle muscular layer of cardiac muscle fibers; contracts to pump blood from ventricles, relaxes to let atria fill.

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10
Q

What is the pericardium?

A

Fluid-filled double sac surrounding heart; protects from trauma/infection, prevents over-expansion, supports limited motion.

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11
Q

What is the epicardium?

A

Outer protective layer; contains coronary blood vessels and nerves. Also called visceral pericardium.

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12
Q

What are atrioventricular (AV) valves?

A

Valves separating atria from ventricles: tricuspid (RA → RV) and mitral/bicuspid (LA → LV).

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13
Q

What are semilunar (SL) valves?

A

Valves between ventricles and great arteries: aortic (LV → aorta) and pulmonic (RV → pulmonary artery).

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14
Q

What are chordae tendineae?

A

Tendon-like fibers connecting AV valves to papillary muscles, preventing prolapse during systole.

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15
Q

What are papillary muscles?

A

Ventricular muscles that contract with ventricles to hold valves shut through chordae tendineae.

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16
Q

Coronary artery circulation: what does the RCA supply?

A

RV, RA, inferior & posterior LV (~85%), SA node (~60%), AV node (~85%).

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17
Q

Coronary artery circulation: what does the LCA supply?

A

Splits into LAD and circumflex (CX). LAD: anterior LV, most of septum, part of lateral LV. CX: LA, lateral LV, inferior & posterior LV (~15%), SA node (~40%), AV node (~15%).

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18
Q

Why is the LAD called the ‘widow-maker’?

A

Blockage often causes sudden death due to loss of blood supply to large LV area.

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19
Q

What is pulmonary circulation?

A

Blood flow from heart → lungs → back to heart.

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20
Q

What is systemic circulation?

A

Blood flow from heart → body → back to heart.

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21
Q

Flow of blood through the heart (step order)?

A
  1. Superior/inferior vena cava → RA 2. Tricuspid valve → RV 3. Pulmonic valve → Pulmonary artery → Lungs 4. Pulmonary veins → LA 5. Mitral valve → LV 6. Aortic valve → Aorta → Body
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22
Q

Sympathetic vs parasympathetic effect on heart?

A

SNS: ↑HR, AV conduction, contractility (epi/norepi). PNS: ↓HR, ↓AV conduction (acetylcholine).

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23
Q

What is cardiac conduction?

A

System that controls the heart’s electrical activity to coordinate contractions and maintain blood flow.

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24
Q

What is the cardiac action potential?

A

Result of separated electrical charges (ions) creating potential energy, causing electrical activity in heart cells.

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25
Key positive ions in cardiac function?
* Sodium (Na+) * Potassium (K+) * Calcium (Ca2+)
26
Key negative ion in cardiac function?
Chloride (Cl-).
27
What are the phases of electrical flow?
* Polarization (ready) * Depolarization (discharge) * Repolarization (recovery)
28
What is polarization?
Ready state; cell interior is negative (-90 mV). Prepares cells for action.
29
What is depolarization?
Sodium ions enter cell; interior becomes positive (+20 mV); triggers contraction.
30
What is repolarization?
Potassium exits, sodium and calcium pumped out; cell returns to negative state.
31
What are pacemaker cells?
Specialized cells that initiate heartbeat (SA node, AV node, Purkinje).
32
What are contractile cells?
Myocardial cells that contract when stimulated by electrical signals.
33
Properties of heart muscle?
* Automaticity * Excitability * Conductivity * Contractility
34
Define automaticity.
Ability to generate impulses without external stimulus.
35
Define excitability.
Ability to respond to electrical, chemical, or mechanical stimulation.
36
Define conductivity.
Ability to transmit impulses to adjoining cardiac cells.
37
Define contractility.
Ability of myocardial cells to shorten and contract when stimulated.
38
List the conduction system in order.
SA node → Internodal tracts → AV node → Bundle of His → Bundle branches → Purkinje fibers.
39
What is the SA node?
Natural pacemaker; in right atrium; rate 60–100 bpm.
40
What are internodal pathways?
* Anterior (Bachmann’s bundle to LA) * Middle (Wenckebach) * Posterior (Thorel)
41
What is the AV node?
Located in RA; delays impulse; rate 40–60 bpm; allows ventricles to fill.
42
What is the Bundle of His?
Upper septum; conducts impulse from AV node to bundle branches.
43
What is the right bundle branch?
Conducts impulses to RV.
44
What is the left bundle branch?
Splits into fascicles; supplies LV and septum.
45
What are Purkinje fibers?
Spread into ventricles; intrinsic rate 20–40 bpm; cause contraction of ventricles.
46
What is systole?
Contraction phase; atria and ventricles contract; AV valves close; semilunar valves open.
47
What is diastole?
Relaxation phase; atria/ventricles fill; semilunar valves close; AV valves open.
48
What does the PQRST complex represent?
Electrical activity of one complete heartbeat on an EKG.
49
What is atrial kick?
Extra 10–30% blood added to ventricles when atria contract.
50
What is stroke volume?
Amount of blood ejected per beat (70–80 mL, ~50% of volume).
51
What is ejection fraction?
Percentage of blood pumped per beat; normal 50–65%, <40% abnormal.
52
What is cardiac output?
Stroke volume × HR; normal 4–8 L/min.
53
What is an EKG?
Graphical recording of the heart’s electrical activity; shows rhythm and conduction.
54
Define waveform.
A curve representing electrical activity.
55
Define complex.
Group of waveforms together (e.g., QRS).
56
Define interval.
Time between two points on EKG.
57
Define segment.
Flat line between waveforms.
58
Define isoelectric line.
Baseline when no electrical activity.
59
What does the P wave represent?
Atrial depolarization; atria contract.
60
What does the QRS complex represent?
Ventricular depolarization; ventricles contract; <0.10 sec.
61
What does the T wave represent?
Ventricular repolarization; relaxation phase.
62
What is the PR interval?
Start of P to start of QRS; 0.12–0.20 sec; represents atrial depolarization + AV node delay.
63
What is the ST segment?
Flat line after QRS; isoelectric; represents end of ventricular depolarization before repolarization.
64
What is the QT interval?
Start of QRS to end of T wave; entire ventricular cycle.
65
What is the PP interval?
Time between two P waves; atrial rhythm.
66
What is the RR interval?
Time between two R waves; ventricular rhythm.
67
What is the J point?
Junction between QRS end and ST segment.
68
Methods to calculate heart rate?
* 6-sec method * Large box method * Small box method
69
Describe 6-second method.
Count R waves in 6 sec strip × 10; fast, least accurate.
70
Describe large box method.
300 ÷ large boxes between R waves.
71
Describe small box method.
1500 ÷ small boxes between R waves; most accurate.
72
How to assess rhythm?
Check R-R interval regularity, presence of P waves, PR interval consistency.
73
What are reasons to perform an EKG?
* Detect arrhythmias * Effects of drugs * Ischemia * Chamber enlargement * Electrolyte imbalances * Monitor before/after procedures
74
What are artifacts?
Unwanted signals on EKG caused by patient movement, poor contact, or electrical interference.
75
What causes wandering baseline?
Loose/dry electrodes, breathing, movement; appears as wavy baseline.
76
How to prevent wandering baseline?
Clean skin, secure electrodes, instruct patient on stillness.
77
What is somatic tremor?
Muscle movement; uneven spikes; caused by shivering, nervousness, seizures, Parkinson’s.
78
How to prevent somatic tremor?
Warm blankets, comfortable temp, proper positioning, reduce anxiety.
79
What is AC interference?
60-cycle interference from electronics; uniform sharp spikes.
80
How to prevent AC interference?
Turn off nearby devices, proper grounding, avoid wall outlets with interference.
81
What is interrupted baseline?
Breaks in tracing; usually loose leads or broken wires.
82
EKG lead I normal deflection?
Positive; if negative, electrodes misplaced.
83
What are EKG leads?
Electrodes that capture heart’s electrical signals from different angles.
84
What are the 3 main types of EKG?
* 3-lead * 5-lead * 12-lead
85
Purpose of a 3-lead EKG?
Basic monitoring; emergency/transport; monitors rhythm; uses Einthoven’s Triangle.
86
Electrode placement for 3-lead?
* RA (white, below right clavicle) * LA (black, below left clavicle) * LL (red, left lower rib cage)
87
Purpose of 5-lead EKG?
Expanded monitoring (ICU, Holter); detects arrhythmias, ischemia; 4 limb leads + 1 chest lead.
88
Electrode placement for 5-lead?
* RA white * LA black * LL red * RL green * V1 brown (4th ICS, right sternal border)
89
Purpose of 12-lead EKG?
Gold standard; 10 electrodes, 12 views; diagnoses infarctions, conduction issues.
90
Which leads are anterior?
V1–V4.
91
Which leads are lateral?
I, aVL, V5, V6.
92
Which leads are inferior?
II, III, aVF.
93
What are posterior leads?
V7 (post axillary), V8 (midscapular), V9 (paraspinal); detect posterior infarctions.
94
What is a right-sided EKG?
Modified placement for RV infarction or dextrocardia; precordial leads placed on right side.
95
How to adjust for pediatric EKG?
Electrodes closer together; smaller patches; V3/V4 moved to 4th ICS.
96
How to handle limb amputations in EKG?
Place electrodes on remaining limb portion or torso; maintain color coding.
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